By the time diseases of the retina are detected, serious damage has often already been done. An advanced optical imaging instrument called the adaptive optics scanning laser ophthalmoscopy (AOSLO) can be used to directly visualize the cellular structure of the retina in the living human eye. Adaptive optics is a technology for measuring and correcting the optical imperfections in the human eye. When adaptive optics is combined with an imaging platform, highly detailed images of the human retina can be acquired. Through collaboration with both intramural and extramural collaborators, we have assembled and deployed a state-of-the-art custom-built adaptive optics instrument in the NEI eye clinic. Drs. Dubra and Carroll of the Medical College of Wisconsins Advanced Ocular Imaging Program were selected for this effort. Integration of the AOSLO into an eye clinic will facilitate translational research efforts at the NIH Clinical Center. In addition, best practices were gathered from the worlds leading adaptive optics laboratories in order to improve and streamline the clinical use of adaptive optics instruments. We collaborated with Dr. Ethan Rossi from the University of Rochester to deploy an advanced fixation system that significantly simplifies the image acquisition process. Intramural collaborations were also essential for the successful implementation of the NEI AOSLO and infrastructure. Randy Pursley and Tom Pohida provided custom electronics support and Howard Metger provided custom-machining for various modules within the adaptive optics instrument. Currently the intepretation of adaptive optics images is challenging in patients with diseases since in most cases highly detailed images of clinical lesions have never been imaged before. Therefore we are starting to assemble a database of images of eyes from healthy volunteers. Characterization of this data will aid in the interpretation of patient data and will be useful for statistical comparisons. We have also initiated a relationship with the Medical College of Wisconsin in the area of adaptive optics data banking, which will help accelerate the development of adaptive optics image databases and provide access to adaptive optics data to other investigators interested in secondary analyses of data. We are also exploring methods for longitudinal tracking of single cells in the living human eye, in patients with various retinal degenerations. Monitoring the progression of disease in an actual patient at the cell-to-cell level may provide new insights into the mechanisms of retinal diseases that cause blindness. A significant effort in the area of image processing and image analysis is underway. Development of novel algorithms may lead to new imaging biomarkers and metrics for the quantitative evaluation of disease. Given that the processing of adaptive optics data is highly time consuming and labor intensive, we are also interested in develop strategies to improve the throughput of adaptive optics data processing.
